There it is again! That distinct flutter in your chest that kicks up your heart rate and leaves you feeling a bit breathless. It might feel as though your heart just skipped a beat or flip-flopped in your chest and you’re left wondering, “Did my body just take me on a little roller coaster ride or was that a heart palpitation?” For most women without underlying cardiovascular issues, the experience of a heart palpitation can range from a mild sensation to moderate discomfort, not because they are typically painful, but because they can make you acutely aware of your heartbeat.

Heart palpitations can be associated with menopause, anxiety, hormonal fluctuations, hyperthyroidism, nutrient deficiencies, excessive caffeine, medications, mitral valve prolapse and heart arrhythmias. Heart palpitations are common and usually inconsequential. Although they can occur in the absence of heart disease, they may also be associated with a serious heart condition. If they are of new onset, occur frequently, and are associated with symptoms of dizziness, syncope, and pain, seeing your doctor for a complete evaluation is warranted.

Heart Palpitations and Hormones

Heart palpitations related to hormonal fluctuations can occur in women of all ages. Premenopausal women may experience heart palpitations during specific phases of their menstrual cycle when hormones are fluctuating. Pregnant women may also experience palpitations from rising hormones, increased blood volume and anemia. Heart palpitations in menopausal women occur from fluctuating and declining hormone levels.

Sex hormones can influence the rhythm of the heart by modifying ion channels that regulate electrical activity as well as regulating input from the autonomic nervous system (ANS). Menopause can be associated with a decrease in heart rate variability (HRV) due to either reduced parasympathetic or increased sympathetic outflow to the heart. Changes in electrical activity of the heart along with an increase in sympathetic tone, catecholamines (epinephrine or adrenaline, norepinephrine or noradrenaline) and cortisol can contribute to the development of heart palpitations.

Much of the medical literature on heart palpitations and hormones confirms that women in midlife and those entering menopause do experience palpitations.

What Is a Heart Palpitation?

A palpitation is a discernable change in cardiac rate or rhythm. There are four main physiological causes of palpitations:

  • Extra-cardiac stimulation of the sympathetic nervous system (SNS), resulting in excess production of catecholamines and cortisol.
  • Sympathetic overdrive, which may occur from stress, anxiety, panic disorder, hypoglycemia, and hypoxia.
  • Increased circulatory volume, which may result in vasodilation and decreased blood pressure.
  • Abnormal heart rhythms such as supraventricular tachycardia and atrial fibrillation, to name a few. Abnormal heart rhythms can range from mild to life-threatening and should always be treated appropriately.

Stressors and Midlife

Much of the medical literature on heart palpitations and hormones confirms that women in midlife and those entering menopause do experience palpitations. This seems to fall into the, “thanks for telling me what I already know” category. We know they’re happening, but why?

A deeper dive into the literature reveals some correlations that are not too surprising. More frequent and severe heart palpitations are associated with insomnia, a higher level of perceived stress, depression, and poor quality of life. Less physical activity, past or current smoking, and surgical versus natural menopause also contribute to increased frequency and severity of heart palpitations. Most of these correlates can be linked to a heightened stress response, and as mentioned above, heart palpitations can occur under increased SNS activity or activation of the stress response.